Magnetic Resonance Imaging of Renal Arteriovenous Malformation: A Case Report

腎動靜脈畸形之磁振造影影像：病例報告

洪裕正(Yu-Cheng Hong) ； 周成德(Chen-Te Chou) ； 李國維(Kwa-Whei Lee)

《中華放射線醫學雜誌》 32卷1期 (2007/03) Pp. 51-55

摘要

一位四十四歲女性患者，因突發性大量血尿到院求診，逆行性腎盂攝影檢查顯示不規則項充缺損在腎盂腎盞系統位置，疑似腎上皮腫瘤。進一步做磁振造影檢查顯示無信號病灶在右腎中間腎盂旁位置，且在注射完對比劑後呈現糾纏血管叢顯影增加現象，合併多處屢管及腎靜脈與下腔靜脈的早期顯影。由磁振造影檢查顯示，可以正確診斷為腎動靜脈畸形，病患隨即接受動脈栓塞手術治療。症狀也因此消失，影像檢查特性和栓塞治療技術也將被加以討論。先天性腎動靜脈畸形很罕見，目前仍以血管攝影檢查做為診斷標準。而磁振造影為一種非侵入性且準確性高的檢查。以此病例做磁振造影術檢查得以正確、快速診斷出腎動靜脈畸形，由此得以證明磁振造影在診斷病症的重要性。

並列摘要

We report a patient with renal arteriovenous malformation (AVM), which was difficult to differentiate from renal pelvic tumor by retrograde pyelography (RP). A 44-year-old female visited our hospital due to sudden onset of gross hematuria. RP revealed irregular filling defect in the pelvocalyceal system, which could be an urothelial tumor and/or blood clot. Magnetic resonance imaging (MRI) showed several tiny flow voids adjacent to the renal pelvis with tangle of enhancing vessels in the mid pole of the right kidney and multiple fistubus connections with early filling of renal vein and IVC. Therefore, the diagnosis was renal AVM. The patient was treated with superselective transarterial embolization (TAE) with n-butyl 2-cyanoac-rylate (NBCA). The symptom resolved after TAE. Imaging modalities and endovascular techniques for diagnosis and treatment of renal AVM were discussed.
Congenital renal AVMs are rare. Although arteriography still remain the gold standard, MRI may be useful as a non-invasive tool for the diagnosis of renal AVM.